R H Scofield1, E J Lopez, S J McNabb. 1. Section of Endocrinology, University of Oklahoma College of Medicine, Oklahoma City 73104.
Abstract
OBJECTIVE: We assessed the incidence, risk factors, and prognostic implications of tularemia pneumonia in Oklahoma from 1982 through 1987. DESIGN: We retrospectively reviewed all reported case-patients over the six-year period 1982-1987. SETTING: Department of Health in Oklahoma, where tularemia is known to be endemic. PATIENTS: Of 128 patients with tularemia who entered the study, 32 had pulmonary involvement. MAIN RESULTS: Compared to patients without pulmonary involvement, those with tularemia pneumonia were older (52 vs 32, p less than .0001), less likely to give a history of vector exposure (25% vs 7%, p less than .05), more likely to present with typhoidal illness (56% vs 15%, p less than .0001), hospitalized longer (11.6 vs 4.7 days, p less than .001), more likely to have a positive culture (9 vs 7, p less than .01), and more likely to die (4 vs 1, p less than .01). CONCLUSIONS: Patients with tularemia pneumonia often present without historical or physical examination findings that suggest the diagnosis; thus, tularemia pneumonia often cannot be distinguished from other cases of community-acquired pneumonia. Therefore, especially in areas where the disease is endemic, tularemia must be considered in patients with pneumonia.
OBJECTIVE: We assessed the incidence, risk factors, and prognostic implications of tularemia pneumonia in Oklahoma from 1982 through 1987. DESIGN: We retrospectively reviewed all reported case-patients over the six-year period 1982-1987. SETTING: Department of Health in Oklahoma, where tularemia is known to be endemic. PATIENTS: Of 128 patients with tularemia who entered the study, 32 had pulmonary involvement. MAIN RESULTS: Compared to patients without pulmonary involvement, those with tularemia pneumonia were older (52 vs 32, p less than .0001), less likely to give a history of vector exposure (25% vs 7%, p less than .05), more likely to present with typhoidal illness (56% vs 15%, p less than .0001), hospitalized longer (11.6 vs 4.7 days, p less than .001), more likely to have a positive culture (9 vs 7, p less than .01), and more likely to die (4 vs 1, p less than .01). CONCLUSIONS:Patients with tularemia pneumonia often present without historical or physical examination findings that suggest the diagnosis; thus, tularemia pneumonia often cannot be distinguished from other cases of community-acquired pneumonia. Therefore, especially in areas where the disease is endemic, tularemia must be considered in patients with pneumonia.
Authors: Tina Guina; Lynda L Lanning; Kristian S Omland; Mark S Williams; Larry A Wolfraim; Stephen P Heyse; Christopher R Houchens; Patrick Sanz; Judith A Hewitt Journal: Front Cell Infect Microbiol Date: 2018-04-04 Impact factor: 5.293